Identification of patients' needs and expectations in a cataract clinic connected with a university public hospital

PURPOSE: To identify patients' needs and expectations in a cataract clinic connected with a university public hospital - Cataract Institute - Department of Ophthalmology - Paulista School of Medicine (UNIFESP). METHOD: A descriptive transverse study was carried out with the patients enrolled in the clinic, distributed in two groups: those who were operated on and those who were not. Patients were approached in two stages: 1) conduct the study in four focus groups to identify the patients' most valued attributes (qualitative study); 2) a questionnaire was designed based on the main attributes and was submitted to a sample of patients (quantitative study). RESULTS: The patients' main expectations are related to: 1) the treatment results; 2) more comfortable waiting facilities; 3) be treated with respect by all the caregivers; and 4) the technological devices used in their treatments. The highest rates of satisfaction were the information material, physician care, and medical devices; the lowest rates of satisfaction were telephone service, physical environment, queue arrangements, and making contact. CONCLUSIONS: The evaluation of the services as well as the institution's public image is positive. The main reasons for choosing the clinic are related to economic and financial aspects and the majority of the patients would use the services again and would also recommend the clinic to other people.OBJETIVO: Identificar as necessidades e expectativas dos pacientes de uma clínica de catarata vinculada a um hospital público universitário. MÉTODOS: Foi realizado um estudo descritivo transversal em amostra de pacientes do Instituto da Catarata (InCat) - Departamento de Oftalmologia - Escola Paulista de Medicina (UNIFESP), distribuídos em dois grupos: pacientes não operados de catarata e pacientes operados. A abordagem dos pacientes foi feita em duas etapas: 1) realização de quatro grupos de foco (dois para cada grupo) para se determinar os atributos mais valorizados pelos pacientes (estudo qualitativo); 2) elaboração de questionário com perguntas relacionadas aos atributos, que foi aplicado a uma amostra representativa dos pacientes da clínica (estudo quantitativo) para saber o grau de satisfação em relação aos atributos. RESULTADOS: As principais expectativas estão relacionadas: 1) ao resultado do tratamento; 2) a uma estrutura que acomode a todos confortavelmente; 3) serem respeitados por todos os profissionais que os atendem; e 4) à tecnologia usada no tratamento. Os maiores índices de satisfação referem-se ao material informativo, ao atendimento dos médicos e à aparelhagem; os menores índices relacionam-se ao atendimento telefônico, ao espaço físico, à organização das filas e à dificuldade de contato. CONCLUSÕES: A avaliação da qualidade do atendimento e da imagem do InCat é positiva. As razões de escolha relacionam-se com aspectos econômicos e financeiros e a maioria dos pacientes voltaria a utilizar os serviços da clínica e a indicaria para outras pessoas.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP, Depto. de OftalmologiaSciEL

Caracterização da produção científica em Educação Especial na Biblioteca Virtual em Saúde (BVS): um estudo bibliométrico

Objective: To characterize, through bibliometric approach, the scientific literature in this Special Education in the databases of the Virtual Health Library (VHL). The VHL is coordinated by BIREME - Specialized Center of the Pan American Health Organization whose objective is to promote the dissemination and use of scientific information in health. Method: The research methodology was performed by observing the following steps: a literature review on education special and bibliometrics, data collection from the site of BIREME about the presence of special education in the databases, organization, processing and bibliometric analysis of data collected using the software MS Excel and Vantage Point. Results: indicators produced allow signal that the predominant language of scientific production was the Portuguese and the majority of records were written individually, the themes addressed were psychology and developmental psychology. Conclusion: These bibliometric indicators characterizing the state of the art of scientific literature in Special Education at the various bases Data Bireme and also showed a field of interconnections between Health Sciences and Special Education.Objetivo: Caracterizar, por meio da abordagem bibliométrica, a produção científica em Educação Especial presente nas bases de dados da Biblioteca Virtual em Saúde (BVS). A BVS é coordenada pela Bireme - Centro Especializado da Organização Pan-Americana de Saúde cujo objetivo é promover a disseminação e uso da informação científica em saúde. Método: A metodologia da pesquisa foi realizada observando-se os seguintes passos: revisão de literatura sobre educação especial e bibliometria; coleta de dados no site da Bireme sobre a presença da educação especial nas bases de dados; organização, tratamento bibliométrico e análise dos dados coletados utilizando os softwares MS Excel e Vantage Point.Resultados: Foram produzidos indicadores que permitiram verificar que o idioma predominante das produções científicas foi o Português; a maioria dos registros foi escrita de forma individual; as temáticas mais abordadas foram a psicologia e psicologia do desenvolvimento. Conclusão: Esses indicadores bibliométricos caracterizaram o estado da arte da produção científica em Educação Especial nas diversas bases de dados da Bireme e também demonstraram a interdisciplinaridade entre Ciências da Saúde e a Educação Especial. Palavras-chave: Educação Especial; Análise bibliométrica; Avaliação da produção científica

Produção científica sobre avaliação da visão em crianças: um estudo bibliométrico na base de dados LILACS

This study aimed to perform bibliometric analysis of scientific literature on evaluation of vision available in the database Lilacs. The research methodology has observed the following steps: review of literature on the evaluation of vision and bibliometrics, collection of data in the database Lilacs, organization, processing and bibliometric analysis of data collected using the software MS Excel. Using the search terms “visual assessment”, “assessment of vision”, “functional assessment of vision”, “visually impaired”, “low vision” and “disorders of vision”, being selected 27 articles. As a results were produced the following indicators: the predominant languages of scientific productions were Portuguese and Spanish, the original article written in co-authorship is the predominant type of publication, the themes discussed were: low vision, visual acuity, amblyopia and glaucoma. It was also noted that not all authors have specifically or on assessments of vision, and proposed the cognitive assessment and quality of life of visually impaired. It is advisable to conduct further research to demonstrate the importance of early assessment of vision in children, to ensure that the intervention, when necessary, take place as soon as possible and prevent the delay caused by visual impairment. It should also ensure that these visual findings are complementary with assessments that characterize situations in which individuals who already have some type of disability can use their vision more effectivelyhttp://dx.doi.org/10.5902/1984686X4412Este estudo teve por objetivo realizar análise bibliométrica da produção científica sobre avaliação da visão em crianças disponível na base de dados Lilacs. A metodologia da pesquisa observou os seguintes passos: revisão de literatura sobre avaliação da visão e bibliometria; coleta de dados na base de dados Lilacs; organização, tratamento bibliométrico e análise dos dados coletados utilizando o software MS Excel. Utilizando as expressões de busca “avaliação visual”, “avaliação da visão”, “avaliação funcional da visão”, “portadores de deficiência visual”, “baixa visão” e “transtornos da visão”, foram selecionados 27 artigos. Como resultados foram produzidos os seguintes indicadores: os idiomas predominantes das produções científicas foram o português e o espanhol; o artigo original escrito em coautoria é o tipo de publicação predominante, as temáticas mais abordadas foram: “baixa visão”, “acuidade visual”, “ambliopia” e “glaucoma”. Ficou constatado também que nem todos os autores trataram especificamente sobre avaliações da visão, sendo proposta também a avaliação cognitiva e da qualidade de vida de deficientes visuais. Torna-se recomendável a realização de novas pesquisas que demonstrem a importância da avaliação precoce da visão em crianças, visando que a intervenção, quando necessária, ocorra o mais cedo possível e previna os possíveis atrasos ocasionados pela deficiência visual. Deve-se também garantir que estes achados oftalmológicos se complementem com avaliações que caracterizem em quais situações os indivíduos que já possuem algum tipo de deficiência possam utilizar com maior eficácia sua visão. Palavras-chave: Baixa visão. Transtornos da visão. Bibliometria.

Postural assessment of patients with non-conventional knee endoprosthesis

Objective:To investigate the correlation between the sagittal and frontal alignment and possible postural asymmetries found in patients submitted to total knee stent placement for osteosarcoma.Methods:Twenty two individuals were divided into two groups according to tumor location: femur group (13 patients) and tibia group (nine patients), who were evaluated through postural analysis software (SAPO).Results:No statistically significant difference was found between groups, supporting previous result showing that both groups present the same postural asymmetries.Conclusion:We conclude that both groups have the same postural imbalances, especially the knee of the affected limb that presents hyperextension and center of gravity shifted anteriorly and laterally to the non-affected limb, indicating changes in weight bearing and influencing the gait pattern and balance. Level of Evidence II, Prospective Comparative Study.Universidade Federal de São Paulo (UNIFESP) Instituto de Oncologia PediátricaUNIFESP, Instituto de Oncologia PediátricaSciEL

Deciphering the Role of RND Efflux Transporters in Burkholderia cenocepacia

Burkholderia cenocepacia J2315 is representative of a highly problematic group of cystic fibrosis (CF) pathogens. Eradication of B. cenocepacia is very difficult with the antimicrobial therapy being ineffective due to its high resistance to clinically relevant antimicrobial agents and disinfectants. RND (Resistance-Nodulation-Cell Division) efflux pumps are known to be among the mediators of multidrug resistance in Gram-negative bacteria. Since the significance of the 16 RND efflux systems present in B. cenocepacia (named RND-1 to -16) has been only partially determined, the aim of this work was to analyze mutants of B. cenocepacia strain J2315 impaired in RND-4 and RND-9 efflux systems, and assess their role in the efflux of toxic compounds. The transcriptomes of mutants deleted individually in RND-4 and RND-9 (named D4 and D9), and a double-mutant in both efflux pumps (named D4-D9), were compared to that of the wild-type B. cenocepacia using microarray analysis. Microarray data were confirmed by qRT-PCR, phenotypic experiments, and by Phenotype MicroArray analysis. The data revealed that RND-4 made a significant contribution to the antibiotic resistance of B. cenocepacia, whereas RND-9 was only marginally involved in this process. Moreover, the double mutant D4-D9 showed a phenotype and an expression profile similar to D4. The microarray data showed that motility and chemotaxis-related genes appeared to be up-regulated in both D4 and D4–D9 strains. In contrast, these gene sets were down-regulated or expressed at levels similar to J2315 in the D9 mutant. Biofilm production was enhanced in all mutants. Overall, these results indicate that in B. cenocepacia RND pumps play a wider role than just in drug resistance, influencing additional phenotypic traits important for pathogenesis

Sleep and immune function

Sleep and the circadian system exert a strong regulatory influence on immune functions. Investigations of the normal sleep–wake cycle showed that immune parameters like numbers of undifferentiated naïve T cells and the production of pro-inflammatory cytokines exhibit peaks during early nocturnal sleep whereas circulating numbers of immune cells with immediate effector functions, like cytotoxic natural killer cells, as well as anti-inflammatory cytokine activity peak during daytime wakefulness. Although it is difficult to entirely dissect the influence of sleep from that of the circadian rhythm, comparisons of the effects of nocturnal sleep with those of 24-h periods of wakefulness suggest that sleep facilitates the extravasation of T cells and their possible redistribution to lymph nodes. Moreover, such studies revealed a selectively enhancing influence of sleep on cytokines promoting the interaction between antigen presenting cells and T helper cells, like interleukin-12. Sleep on the night after experimental vaccinations against hepatitis A produced a strong and persistent increase in the number of antigen-specific Th cells and antibody titres. Together these findings indicate a specific role of sleep in the formation of immunological memory. This role appears to be associated in particular with the stage of slow wave sleep and the accompanying pro-inflammatory endocrine milieu that is hallmarked by high growth hormone and prolactin levels and low cortisol and catecholamine concentrations

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo